Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Secondary Amenorrhea Testing Algorithm
Clinical Background
Infertility is defined as the failure to achieve a pregnancy during 12 months of frequent, unprotected intercourse.
Epidemiology
- Prevalence - 10-15% of couples in U.S.
Etiology
- Female factors - account for about 50% of the cases
- Ovarian dysfunction
- Aging
- Endocrine disorders
- Polycystic ovarian syndrome (PCOS)
- Premature ovarian failure
- Tubal factors
- Uterine/cervical factors
- Congenital anomaly
- Fibroids
- Polyps
- Poor cervical quality
- Other
- Male factors - account for about 25% of the cases
- Primary/secondary hypogonadism
- Orchitis
- Altered sperm
- Unknown
- Unexplained - account for about 25% of the cases
Clinical Presentation
- Female
- Irregular menses
- Galactorrhea
- Signs of hyperandrogenism (eg, hirsutism)
- Male
- Varicocele or hydrocele
- Signs of androgen deficiency (eg, small testes)
- Signs of infection (eg, epididymitis)
Treatment
- Intrauterine insemination, ovulation induction
- Highest pregnancy rate per cycle from in vitro fertilization (IVF)
- Ovarian stimulation followed by egg retrieval
- Egg fertilization, embryo culture
- Embryo transfer to uterus
See Also
Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Secondary Amenorrhea Testing Algorithm
Diagnosis
Diagnosis
- Indications for testing - inability to achieve pregnancy within 12 months
- Female
- Full physical examination including assessment of body mass index
- Confirm rubella immunity
- Cervical cytology and screening for sexually transmitted infections
- Document ovulation - midluteal progesterone level, urinary luteinizing hormone
- Determine etiology if ovulatory dysfunction is suspected - follicle stimulating hormone (FSH), prolactin, thyroid stimulating hormone, 17-hydroxyprogesterone, testosterone
- Assess ovarian reserve - FSH and estradiol measures on day 3 of menstrual cycle
- Assess anatomic dysfunction-transvaginal ultrasound, hysterosalpingography, laparoscopy
- Male
- Assess androgen deficiency - LH, FSH, testosterone
- Assess spermatic function - semen analysis (at least 2 specimens)
Refer to Infertility topic at www.arupconsult.com for a list of Normal Semen Parameters
- Consider infection evaluation - complete blood count (CBC), gonorrhea and chlamydia cultures and urinalysis
Algorithm(s)
PDF algorithm(s) available at www.arupconsult.com.
Secondary Amenorrhea Testing Algorithm
Tests generally appear in the order most useful for common clinical situations
| Test name: Luteinizing Hormone and Follicle Stimulating Hormone
|
| ARUP #: 0070193 |
| Methodology: Electrochemiluminescent Immunoassay
|
| Use: Determine etiology of infertility |
| Test name: Prolactin
|
| ARUP #: 0070115 |
| Methodology: Chemiluminescent Immunoassay
|
| Use: Determine etiology of infertility |
| Test name: Dehydroepiandrosterone Sulfate, Serum
|
| ARUP #: 0070040 |
| Methodology: Electrochemiluminescent Immunoassay
|
| Use: Determine etiology of infertility |
| Limitations: |
| Follow-up:
|
| Test name: Testosterone Free, Females or Children
|
| ARUP #: 0081059 |
Methodology: Tandem Mass Spectrometry
The concentration of free testosterone is derived from a mathematical expression based on the constant for the binding of testosterone to sex hormone binding globulin.
|
| Use: Determine etiology of infertility |
| Test name: Estradiol, Adult Premenopausal Female, Serum or Plasma
|
| ARUP #: 0070045 |
| Methodology: Chemiluminescent Immunoassay
|
| Use: Diagnose PCOS |
| Test name: Thyroid Stimulating Hormone
|
| ARUP #: 0070145 |
| Methodology: Electrochemiluminescent Immunoassay
|
| Use: Determine etiology of infertility |
| Test name: Semen Analysis % Abnormal 0020361 |
| ARUP #: |
| Methodology: |
| Use: Determine if etiology of infertility is male related |
| Limitations: Time-sensitive test |
Additional Tests Available
| Test name: Testosterone, Females or Children
|
| ARUP #: 0081058 |
| Methodology: High Performance Liquid Chromatography/Tandem Mass Spectrometry
|
| Comments: |
| Test name: Testosterone, Free & Total (Includes Sex Hormone Binding Globulin), Females or Children
|
| ARUP #: 0081056 |
Methodology: Tandem Mass Spectrometry
The concentration of free testosterone is derived from a mathematical expression based on the constant for the binding of testosterone to sex hormone binding globulin.
|
| Comments: |
| Test name: Testosterone, Bioavailable & Sex Hormone Binding Globulin (Includes Total Testosterone), Females or Children
|
| ARUP #: 0081057 |
Methodology: High Performance Liquid Chromatography/Tandem Mass Spectrometry
The concentrations of free and bioavailable testosterone are derived from mathematical expressions based on constants for the binding of testosterone to albumin and/or sex hormone binding globulin.
|
| Comments: Determine etiology of infertility |
| Test name: Inhibin B
|
| ARUP #: 0070413 |
| Methodology: Enzyme-Linked Immunosorbent Assay
|
| Comments: |
| Test name: Luteinizing Hormone (LH), Urine
|
| ARUP #: 0081113 |
| Methodology: Chemiluminometric Immunoassay
|
| Comments: Determine etiology of infertility |
| Test name: Follicle Stimulating Hormone, Serum
|
| ARUP #: 0070055 |
| Methodology: Electrochemiluminescent Immunoassay
|
| Comments: Determine etiology of infertility |
| Test name: Progesterone
|
| ARUP #: 0070110 |
| Methodology: Electrochemiluminescent Immunoassay
|
| Comments: Determine etiology of infertility |
| Test name: Estriol, Serum
|
| ARUP #: 0070051 |
| Methodology: Chemiluminescent Immunoassay
|
| Comments: |
References
Guidelines
Consensus on infertility treatment related to polycystic ovary syndrome. Hum Reprod.
2008;
23(
3):
462-477.
Cited References
Balen AH, Rutherford AJ. Management of infertility. BMJ.
2007;
335(
7620):
608-611.
General References
Al-Inany H. Female infertility. Clin Evid.
2006;
(
15):
2465-2487.
Balen AH, Rutherford AJ. Management of infertility. BMJ.
2007;
335(
7620):
608-611.
Chow V, Cheung AP. Male infertility. J Reprod Med.
2006;
51(
3):
149-156.
Davis CH III, Hall MN, Kaufman L, Danis P. Clinical inquiries. What is the best way to evaluate secondary infertility?. J Fam Pract.
2007;
56(
7):
573-575.
Jarow JP. Diagnostic approach to the infertile male patient. Endocrinol Metab Clin North Am.
2007;
36(
2):
297-311.
Lewis SE. Is sperm evaluation useful in predicting human fertility?. Reproduction.
2007;
134(
1):
31-40.
Sanders B. Uterine factors and infertility. J Reprod Med.
2006;
51(
3):
169-176.
Medical Reviewers
Meikle, A. Wayne, M.D. Medical Director, RIA and Endocrinology at ARUP Laboratories; Professor of Internal Medicine and Pathology, University of Utah
Roberts, William L. , M.D., Ph.D. Medical Director, Automated Core Laboratory at ARUP Laboratories; Professor, Pathology, University of Utah
Comprehensive Review: July 2008
Last Update: July 2008
